AFTER MANY YEARS of orthokeratology wear, a 16-year-old female patient presented complaining that her recently purchased lenses had become uncomfortable. Her ocular health was unremarkable, vision was good, and her lenses looked to be in good condition, without damage or warpage. However, the lenses had an odd whitish residue and smell. When questioned about her care regimen, she reported that she uses a hydrogen peroxide cleaning and disinfecting solution, but recently purchased extra cases online (to be able to keep one at each of her parents’ homes). She noted that she rinsed her lenses with tap water prior to applying each morning.

Hydrogen peroxide (H₂O₂) solutions have been a mainstay of contact lens cleaning and disinfecting for decades, and current one-step systems are relatively easy to use, well tolerated, and widely available. As GPs are usually replaced annually or even less often, using an effective cleaning system is critical to maintaining comfortable and safe ongoing lens wear, and H₂O₂ is an excellent option for these patients.

H₂O₂ reduces microbial loads in standard International Organization for Standardization (ISO) panels of bacteria, yeast, and mold, and it reduces organic matter on lenses (Gabriel et al, 2021). It also shows efficacy against more aggressive microorganisms linked to patients suffering from microbial keratitis or other adverse events, and superior efficacy when compared to multipurpose solutions against Acanthamoeba trophozoites and cysts (Gabriel et al, 2021). Additionally, H₂O₂ disinfection may work better on bacterial and fungal biofilms than multipurpose solutions (Retuerto et al, 2012).

Beyond the antimicrobial merits of H₂O₂ systems, there are many additional benefits for reusable lens wearers. Lens rubbing is not required for most patients for disinfection, and compliance with use as directed, use of fresh solution daily, regular case replacement, and brand adherence are improved compared to patients using multipurpose solutions (Nichols et al, 2019). H₂O₂ has also been associated with less corneal staining and lid papillae, lower risk of corneal infiltrative events and preservative-related sensitivities, better deposit removal, and, therefore, better long-term comfort (especially in GPs) than multipurpose solutions (Nichols et al, 2019).

There are few potential drawbacks to prescribing an H₂O₂ solution. Cost may be slightly higher, and there is a risk of corneal irritation (or “burn”) from improperly neutralized peroxide. The patient mentioned above had inadvertently purchased cases online that looked appropriate for use with H₂O₂ solution but did not have a neutralizing disc at the bottom (Figure 1). Without neutralization, she was experiencing chronic peroxide exposure (only minimized by the pre-application tap water rinse). After being given an appropriate case and told to rinse only with contact lens saline as needed, her discomfort symptoms resolved. 

With careful and ongoing instruction, contact lens wearers of all types can benefit from the use of H₂O₂ care systems, and this applies especially to lenses that have lower replacement frequencies, like GPs. The cases purchased online were not appropriate for this patient, but incidentally could work well for the initial step of in-office cleaning of GP diagnostic lenses, as the current recommendations for this require a non-neutralizing H₂O₂ lens case (Barnett, 2020).

REFERENCES

1. Gabriel MM, McAnally C, Chen H, Srinivasan S, Manoj V, Garofalo R. Hydrogen Peroxide Disinfecting Solution for Gas Permeable Contact Lenses: A Review of the Antimicrobial Efficacy, Compatibility, and Safety Performance of a One-Step Lens Care System. Clin Optom (Auckl). 2021 Jan 14;13:7-14.

2. Retuerto MA, Szczotka-Flynn L, Ho D, Mukherjee P, Ghannoum MA. Efficacy of care solutions against contact lens-associated Fusarium biofilms. Optom Vis Sci. 2012 Apr;89:382-391. 

3. Nichols JJ, Chalmers RL, Dumbleton K, et al. The Case for Using Hydrogen Peroxide Contact Lens Care Solutions: A Review. Eye Contact Lens. 2019 Mar;45:69-82. 

4. Barnett M. In-Office Contact Lens Disinfection. Contact Lens Spectrum. 2020 Jan;35:17. Available at clspectrum.com/issues/2020/january/contact-lens-care-and-compliance. Accessed 2024 Sep 19.